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Mandated Treatment

Implicit in the power to protect the public health is the power to treat disease carriers against their objections. Since treatment is a less restrictive alternative to quarantine or isolation, it is favored as a disease control measure. A patient who refuses to accept treatment for a contagious disease may be ordered to accept the treatment by a health officer or, depending on the jurisdiction, a court. A common practice is to incarcerate a recalcitrant patient until the patient consents to the treatment. This coerced consent is not obtained as a sham on an informed consent but to obviate the need for physically subduing the patient. It also gives the patient an opportunity to contest the treatment through a habeas corpus proceeding.

Although coerced treatment for a communicable disease violates a person's autonomy, it is permissible under the U.S. Constitution. The alternative is to allow the infected person to threaten the health and life of others. With tuberculosis, failure to force a contagious homeless person to accept treatment may result in the infection of other persons with whom the person comes into contact in shelters. Since many of these contacts, especially the children, are poorly nourished or chronically ill, they will be susceptible to fast-spreading infection that is difficult to treat. This problem is already evident in the high rates of tuberculosis spread in homeless shelters.


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